Bf 24-Month Developmental Surveillance Form

BF   2 4-­‐Month   D evelopmental   S urveillance  

 

Who   t ook   t his   s urvey:     _ ____   M other   _____Father  

_____Both   P arents   _ ____Patient  

 

 

Yes  

No  

1  

Does   y our   c hild   i mitate   a dults?  

 

 

2  

Does   y our   c hild   e ngage   i n   p retend   p lay   ( rocking,   f eeding,   p utt   d oll/stuffed   a nimal   t o   b ed)?  

 

 

3  

Does   y our   c hild   p lay   a longside   o ther   c hildren   ( parallel   p lay)?  

 

 

4  

Does   y our   c hild   r efer   t o   h imself   a s   “ I”   o r   “ me”?  

 

 

5  

Does   y our   c hild   h ave   a   s pecial   a ttachment   t o   a ny   t ransitional   o bjects?  

 

 

6  

Does   y our   c hild   h ave   a   v ocabulary   o f   a t   l east   5 0   w ords?  

 

 

7  

Does   y our   c hild   u se   2 -­‐word   p hrases?  

 

 

8  

Does   y our   c hild   a sk   y ou   t o   r ead   a   b ook?  

 

 

9  

Can   y our   c hild   f ollow   2 -­‐step   c ommands?  

 

 

10  

Can   y our   c hild   n ame   t he   o bject   i n   1   p icture   ( cat,   h orse,   b ird,   d og,   m an,   e tc)?  

 

 

11  

Does   y our   c hild   c omplete   s entences/rhymes   i n   h is   f avorite   b ooks?  

 

 

12  

Does   y our   c hild   c orrect   y ou   i f   y ou   c hange   a   w ord   i n   a   b ook   h e/she   k nows?  

 

 

13  

If   y ou   a sk,   “ Where   i s   _ __?”,   c an   y our   c hild   p oint   t o   a n   o bject   o r   a nimal   i n   a   b ook?  

 

 

14  

Can   y our   c hild   s tack   a t   l east   5   o r   6   b ooks?  

 

 

15  

Does   y our   c hild   m ake   o r   i mitate   h orizontal/circular   s trokes   w ith   a   c rayon?  

 

 

16  

Does   y our   c hild   t urn   b ook   p ages   o ne   a t   a   t ime?  

 

 

17  

Does   y our   c hild   i mitate   f ood   p reparation   ( scrubs,   s tirs,   b eats   a n   e gg,   e tc)?  

 

 

18  

Can   y our   c hild   t hrow   a   b all   o verhand?  

 

 

19  

Can   y our   c hild   g o   u p   a nd   d own   s tairs   o ne   a t   a   t ime?  

 

 

20  

Can   y our   c hild   k ick   a   b all?  

 

 

21  

Can   y our   c hild   j ump   u p?  

 

 

22  

Do   y ou   h ave   a ny   o ther   s pecific   c oncerns   a bout   y our   c hild’s   d evelopment,   l earning,   o r   b ehavior?  

 

 

23  

If   s o,   w hat   a re   t hose   c oncerns?